Organization
PREMISE HEALTH OF CONNECTICUT MEDICAL, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JON LEIZMAN (PRESIDENT)
(216) 479-9063
Entity
Organization
Contact information
Practice address
1100 MILWAUKEE AVE, SOUTH MILWAUKEE, WI 53172-2013
(414) 768-4444
(414) 768-4782
Mailing address
40 BURTON HILLS BLVD, SUITE 200, NASHVILLE, TN 37215-6155
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
07/17/2008
Last updated
08/15/2022
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